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Individual

DR. RANDALL NIX GOODROE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
920 DOUG WHITE DR STE 510, MYRTLE BEACH, SC 29572-4183
(843) 497-7772
(843) 848-7530
Mailing address
920 DOUG WHITE DR STE 510, MYRTLE BEACH, SC 29572-4183
(843) 497-7772
(843) 848-7530

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
23353
SC
207RI0011X
Interventional Cardiology Physician
Primary
23353
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
233535
SC
01
383781722
PRACTICE TAX ID
SC
Enumeration date
09/29/2006
Last updated
01/26/2022
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